TLIP Block Versus Retrolaminar Block on Quality of Recovery After Posterior Lumbar Spine Fusion Surgery (TLIP-RLB-QoR)

Thoracolumbar Interfascial Plane Block Versus Retrolaminar Block on Quality of Recovery After Posterior Lumbar Spine Fusion Surgery: A Prospective Randomized Controlled Trial

This prospective randomized controlled study aims to compare the effects of ultrasound-guided thoracolumbar interfascial plane (TLIP) block versus retrolaminar block on postoperative quality of recovery in patients undergoing posterior lumbar spine fusion surgery. Despite advances in surgical techniques, lumbar spine fusion is associated with significant postoperative pain, which may delay recovery and increase opioid consumption.

Recent approaches emphasize multimodal analgesia and opioid-sparing strategies, including regional anesthesia techniques. Interfascial plane blocks, such as TLIP and retrolaminar block, have gained attention due to their safety and effectiveness in targeting the dorsal rami of spinal nerves supplying the posterior spinal structures.

The primary outcome of this study is postoperative quality of recovery assessed using the Quality of Recovery-15 (QoR-15) questionnaire at 24 hours. Secondary outcomes include pain scores, opioid consumption, time to ambulation, time to oral intake, and postoperative complications.

Study Overview

• Status: Not yet recruiting
• Conditions: Postoperative Pain; Degenerative Lumbar Spine Diseases; Spinal Fusion Surgery
• Intervention / Treatment: Procedure: Thoracolumbar interfascial plane block; Procedure: Retrolaminar block

Detailed Description

This study is a prospective, randomized, controlled, double-blind clinical trial conducted at Assiut University Hospital. A total of 70 adult patients scheduled for elective one- or two-level posterior lumbar instrumented fusion surgery under general anesthesia will be enrolled and randomly allocated into two equal groups.

Patients in Group T will receive ultrasound-guided thoracolumbar interfascial plane (TLIP) block, while patients in Group R will receive ultrasound-guided retrolaminar block. All blocks will be performed after induction of general anesthesia under strict aseptic precautions by an experienced anesthesiologist.

Randomization will be performed using a computer-generated sequence with allocation concealment via sequentially numbered, opaque, sealed envelopes. The study will be conducted in a double-blind manner, where patients and outcome assessors will be blinded to group allocation.

All patients will receive standardized perioperative care based on enhanced recovery principles, including multimodal analgesia and early mobilization. Postoperative pain will be assessed using the Visual Analog Scale (VAS), and rescue analgesia will be administered when needed.

The primary outcome is the QoR-15 score at 24 hours postoperatively. Secondary outcomes include pain scores at predefined intervals, time to first rescue analgesia, total opioid consumption, time to ambulation, time to oral intake, length of hospital stay, and incidence of postoperative complications.

• Study Type: Interventional
• Enrollment (Estimated): 70
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Rehab Mohamed Mostafa Mahmoud, MD (Candidate); Phone Number: +201063303791; Email: rehab.mohamed19@gmail.com
• Study Contact Backup: Name: Mohamed Abo Elhassan, MD (candidate); Phone Number: +201001311044; Email: Aboelhassan@gmail.com

Study Locations

• Egypt
  • Asyut, Egypt
    • Assiut University Hospitals

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adult patients aged 18-65 years
• Male and female patients
• Scheduled for elective one- or two-level posterior lumbar instrumented fusion surgery under general anesthesia
• ASA physical status I-III
• BMI < 35 kg/m²
• Willing to participate and provide informed consent

Exclusion Criteria:

• Patient refusal to participate
• Coagulopathy or anticoagulant therapy
• Infection at the site of block injection
• Known allergy to local anesthetics
• Chronic opioid use (>3 months)
• Severe hepatic, renal, or cardiac dysfunction
• Neurological deficits interfering with pain assessment
• Pregnancy or lactation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Thoracolumbar interfascial plane Block Group; Patients will receive ultrasound-guided thoracolumbar interfascial plane block after induction of general anesthesia.	Procedure: Thoracolumbar interfascial plane block; Ultrasound-guided injection of local anesthetic into the fascial plane between the multifidus and longissimus muscles at the L3 level
Experimental: Retrolaminar Block Group; Patients will receive ultrasound-guided retrolaminar block after induction of general anesthesia.	Procedure: Retrolaminar block; Ultrasound-guided injection of local anesthetic posterior to the vertebral lamina at the L3 level.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Recovery-15 (QoR-15) score at 24 hours postoperatively	Quality of recovery will be assessed using the Quality of Recovery-15 (QoR-15) questionnaire, a validated 15-item patient-reported outcome measure. Scores range from 0 to 150, with higher scores indicating better postoperative recovery. The primary endpoint is the QoR-15 score at 24 hours after surgery.	24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity using Visual Analog Scale (VAS)	Pain will be assessed using a 0-10 Visual Analog Scale, where 0 indicates no pain and 10 indicates worst imaginable pain.	30 minutes, 2, 6, 12, and 24 hours postoperatively
Time to first rescue analgesia	Time from the end of surgery to the first request for rescue analgesia (VAS ≥ 4).	Within 24 hours postoperatively
Total nalbuphine consumption	Total amount of nalbuphine administered within the first 24 hours after surgery (mg).	24 hours postoperatively
Time to first ambulation		From end of surgery to first ambulation, assessed up to 48 hours postoperatively
Time to tolerate oral intake		From end of surgery to first tolerated oral intake, assessed up to 48 hours postoperatively
Length of hospital stay		From surgery until hospital discharge, assessed up to 7 days postoperatively
Incidence of postoperative complications	Includes nausea, vomiting, pruritus, hypotension, bradycardia, hematoma, infection, and local anesthetic systemic toxicity (LAST).	Within 24-48 hours postoperatively

Collaborators and Investigators

• Sponsor: Assiut University

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): June 1, 2027

Study Registration Dates

• First Submitted: April 20, 2026
• First Submitted That Met QC Criteria: May 21, 2026
• First Posted (Actual): May 27, 2026

Study Record Updates

• Last Update Posted (Actual): May 27, 2026
• Last Update Submitted That Met QC Criteria: May 21, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Regional Anesthesia; Quality of Recovery; Postoperative Analgesia; Lumbar Spine Surgery; QoR-15; Retrolaminar Block; TLIP Block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative
• Other Study ID Numbers: TLIP-RLB-QoR-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No